DSE screening accurately predicted post-transplant adverse events
LAS VEGAS — Dobutamine stress echocardiography may be an alternative to invasive angiography for the prediction of major adverse cardiac events and cardiac allograft vasculopathy after heart transplantation, according to data presented at the Heart Failure Society of America Annual Scientific Meeting.
“There is a paucity of data on the accuracy of [dobutamine stress echocardiography] to detect [cardiac allograft vasculopathy] and adverse outcomes when implemented specifically early after heart transplantation,” investigator Jerry D. Estep, MD, of Houston Methodist Hospital, said during a presentation here.
Researchers evaluated 144 patients who received a heart transplantation at a single hospital between 2000 and 2008. Participants underwent annual dobutamine stress echocardiography (DSE) at 1, 2, 3 and 4 years post-transplant, as well as coronary angiography at 5 years post-transplant.
Abnormal DSE at years 1, 2, 3 or 4 was observed in 19% of patients. The researchers indicated a 95% feasibility for obtaining adequate DSE, and noted that 90% of patients with a normal DSE during the first 4 years of analysis did not experience significant cardiac allograft vasculopathy (CAV) by year 5. Incidence of major adverse cardiac events did not differ significantly between those who had abnormal vs. normal DSE.
For the prediction of major adverse cardiac events, researchers observed the following for DSE administered at years 1, 2 and 3 after transplantation:
- DSE at year 1: Sensitivity of 63%; specificity of 96%; negative predictive value (NPV) of 96% and positive predictive value (PPV) of 63% for major adverse events between years 1 and 2 post-transplant;
- DSE at year 2: Sensitivity 60%; specificity 98%; NPV 97% and PPV 60% for events between years 2 and 3;
- DSE at year 3: Sensitivity 53%; specificity 98%; NPV 94% and PPV 75% for events between years 3 and 4.
Among patients with normal DSE results, the researchers observed an NPV of 94% for the detection of disease at 5 years.
They also noted that although DSE was predictive of CAV at 5 years in most cases, target heart rate was not achieved during DSE among cases in which DSE did not predict vasculopathy.
“Based on our experience, the early use of DSE as an annual surveillance strategy to detect CAV at year 5 and monitor for [major adverse cardiac events] annually is associated with an acceptable safety profile,” Estep said. “This noninvasive method has very good specificity, was associated with a good NPV and can be used, in our experience, in lieu of annual invasive angiography.” He also noted that long-term follow-up for years 5 to 10 post-transplantation is currently underway.
For more information:
Orrego CM. Abstract #020. Rapid-Fire Abstracts I. Presented at: the Heart Failure Society of American Annual Scientific Meeting; Sept. 14-17, 2014; Las Vegas.
Disclosure: Cardiology Today could not confirm any relevant disclosures at the time of publication.